What is the Maximum Claim Limit in ESIC

Under the Employee State Insurance Act 1948 there is no maximum limit for ESIC claim amount for getting medical treatment. If an ESIC member fulfills all the eligibility criteria for a certain medical treatment then he or she will get complete treatment for free of cost. Insured members can check their eligibility for various benefits under the ESIC scheme at ESIC IP portal by using their IP number.

Other than medical benefits in ESIC for remaining benefits there is a certain limit for the claim amount, here are the details.

ESIC Benefit Claim Limit
For medical benefitsNo claim limit
Sickness Benefit70% of wages will be paid to the insured person during the
certified sickness period, maximum for 91 days in a year.
Extended Sickness BenefitSickness benefit will be extended to 2 years in the case of
34 malignant and long term diseases and 80% of wages will
be paid to the insured worker.
Enhanced Sickness BenefitFull wages will be paid to male and female workers for
7 days & 14 days respectively during sterilization.
Temporary Disablement90% of wages will be paid as long as disablement continues.
Permanent Disablement90% of wages will be paid as monthly payment depending on the
based on the loss of earning capacity.
Dependents Benefit90% of wages as a monthly payment in case of occupational
hazards.
Funeral Expenses15000 Rs
Atal Bimit Vyakti Kalyan Yojana Scheme25% of daily earnings will be paid to the unemployed insured person for 90 days.
Maternity Benefit100% of wages for 26 weeks.

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